Migraine headache is a universal a...

Migraine headache is a universal and disabling disorder. Less than single in kind third of treated patients report consistently effective arises from their current pharmacologic regimens, and many patients do not solicit treatment. Habitual overuse of acute medications, including triptans, spurred ryes and analgesics, can lead to chronic daily headache. Prophylaxis may render migraine frequency and prevent dosage escalation of acute therapies. Brandes and colleagues investigated whether an antiepileptic medication, topiramate, would be effective in preventing migraines.

Patients who were 12 to 65 years of age and had three to 12 migraines a month were included in the thought Patients who had failed more than pair previous prophylactic medication trials were exclud as were patients taking beta blocker antidepressants, antiepileptic medicines calcium channel blockers, and other medications that might embarrass the trial results. After a washout period of 14 days, followed by dint of a 28-day baseline period, eligible patients were randomized to treatment with placebo or topiramate in a dosage of 50 mg through day, 100 mg per day, or 200 mg by day, with dosages titrated upward in 25-mg weekly increments to the target dosage. After an 18-week maintenance period, patients were eligible to continue an openlabel extension after a blinded seven-week transition.

Patients kept a headache and ransom medication diary. The primary efficacy measure was a comparison of the reduction in migraine frequent occurrence from baseline. Other measures included the proportion of patients responding to treatment; a change in the number of monthly migraine days, severity, and duration; and a change in number of days requiring salvation medication. Of the 483 patients listed 63 in the placebo arrange completed the trial, as did 59 in the 50-mg topiramate collection 63 in the 100-mg assemblage and 70 in the 200-mg form into groups for a total of 255 patients completing the research The mean monthly migraine oftenness in all patients at baseline was 55 and the mean monthly number of migraine days was 65 In all arranges 15 to 24 percent of patients were taking prophylactic medication in the three month before the prospective baseline phase.

Topiramate therapy was associated with a greater reduction in monthly migraine oftenness than was achieved with placebo. When compared with placebo, the difference was statistically significant in patients receiving 100 mg and 200 mg of topiramate, still not in those receiving 50 mg Among placebo patients, headaches were reduc from 56 by means of month to 4.5; in the 100-mg topiramate clump headaches were reduced from 58 to 35 by means of month, and from 5.1 to 30 in patients receiving 200 mg of topiramate by day. The difference at these dosages occurr through one month of treatment and remained statistically significant for the duration of the trial.

A significantly larger proportion of patients in all topiramate clusters had at least a 50 percent reduction in monthly migraine common occurrence compared with the placebo assemblage Topiramate in the higher dosages also was associated with a statistically significant reduction in mean monthly number of migraine days and number of days requiring the use of release medication. Adverse events associated with topiramate occurr in 10 percent or more of patients, leading to discontinuation at some participants.

The authors bring to an end that, compared with placebo, topiramate at dosages of 100 or 200 mg for day significantly reduces migraine common occurrence and the number of days requiring retake medications. Because of adverse ends slow upward titration may enhance tolerability. The inquiry results also suggest that, for migraine prophylaxis, topiramate is at least as effective as other preventive agents, including propranolol, amitriptyline, and valproate.

CAROLINE WELLBERY, MD

Brandes JL et al., for the MIGR-002 contemplation Group. Topiramate for migraine prevention. A randomized controll trial. JAMA February 25 2004;291:965-73

COPYRIGHT 2004 American Academy of Family Physicians

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